J. Dwarswaard (Jolanda)http://repub.eur.nl/ppl/23085/
List of Publicationsenhttp://repub.eur.nl/eur_signature.pnghttp://repub.eur.nl/
RePub, Erasmus University RepositoryFour perspectives on self-management support by nurses for people with chronic conditions: A Q-methodological studyhttp://repub.eur.nl/pub/67576/
Wed, 13 Nov 2013 00:00:01 GMT<div>S.M. van Hooft</div><div>J. Dwarswaard</div><div>S. Jedeloo</div><div>R.A. Bal</div><div>A.L. van Staa</div>
Background: Self-management support is a major task of nurses in chronic care. Several conceptualizations on what self-management support encompasses are described in the literature. However, nurses' attitudes and perceptions related to self-management support are not known. Objective: To reveal distinctive perspectives of nurses toward self-management support in chronic care. Design and methods: A Q-methodological study was conducted in which nurses rank-ordered 37 statements on self-management support. Thereafter they motivated their ranking in semi-structured interviews. Participants and setting: A purposive sample of 49 Dutch nurses with a variety of educational levels, age, and from different healthcare settings was invited by e-mail to participate in the study. Thirty-nine nurses (aged 21-54 years) eventually participated. The nurses worked in the following settings: hospital ( n = 11, 28%), home-care ( n = 14, 36%), mental health care ( n = 7, 17%), elderly care ( n = 6, 15%) and general practice ( n = 1, 3%). Results: Four distinct perspectives on the goals for self-management support were identified: the Coach, the Clinician, the Gatekeeper and the Educator perspective. The Coach nurse focuses on the patient's daily life activities, whereas the nurses of the Clinician type aim to achieve adherence to treatment. The goal of self-management support from the Gatekeeper perspective is to reduce health care costs. Finally, the Educator nurse focuses on instructing patients in managing the illness. Conclusions: The changing role of chronic patients with regard to self-management asks for a new understanding of nurses' supportive tasks. Nurses appear to have dissimilar perceptions of what self-management support entails. These distinct perceptions reflect different patient realities and demand that nurses are capable of reflexivity and sensitivity to patient needs. Different perspectives toward self-management support also call for diverse competencies and consequently, also for adaptation of educational nursing programs.NURSE-CC: Verpleegkundig onderzoeksprogramma in Rotterdam van start.http://repub.eur.nl/pub/40650/
Tue, 01 Jan 2013 00:00:01 GMT<div>A.L. van Staa</div><div>J. Dwarswaard</div>
Verpleegkundigen zijn bij uitstek geschikt
om mensen met chronische aandoeningen
te ondersteunen bij het dagelijks
leven met ziekte, ook wel het
bevorderen van zelfmanagement genoemd.
Hierbij staat gezamenlijke besluitvorming
en eigen regie van patiënten
centraal. In het nieuwe onderzoeksprogramma
NURSE-CC, gefinancierd
door ZonMw binnen het
programma Tussen Weten en Doen,
gaan verpleegkundigen aan de slag
met interventies om het zelfmanagement
van chronisch zieken te ondersteunen.
Ook het verpleegkundig onderwijs
wordt onder de loep genomen.
Erasmus MC, Hogeschool Rotterdam
en Erasmus Universiteit (iBMG) vormen
hiervoor een uniek samenwerkingsverband.General practitioners and changing timeshttp://repub.eur.nl/pub/54253/
Thu, 01 Nov 2012 00:00:01 GMT<div>J. Dwarswaard</div><div>M.J. Trappenburg</div>
De huisarts en de tijdgeesthttp://repub.eur.nl/pub/37340/
Sun, 01 Jan 2012 00:00:01 GMT<div>J. Dwarswaard</div><div>M.J. Trappenburg</div>
Om te onderzoeken of de beroepsethiek van huisartsen veranderd
is door veranderende patiënten en het veranderende
overheidsbeleid hebben we Huisarts & Wetenschap op kwalitatieve
wijze geanalyseerd voor de periode 1957 tot 2008. Daarnaast
hebben we semigestructureerde interviews gehouden met drie
generaties huisartsen. Het onderzoek laat zien dat de
huisartsgeneeskundige beroepsethische normen door de tijd
heen zijn veranderd. In de jaren vijftig en zestig van de vorige
eeuw is de huisarts opvoeder van de patiënt. De huisarts bepaalt
wat goed voor hem was. In de jaren zeventig is de huisarts nog
steeds opvoeder, maar nu wordt het belangrijk om de patiënt op
te voeden tot zelfstandigheid en eigen verantwoordelijkheid.
Deze roep om eigen verantwoordelijkheid is vooral afkomstig van
de huisarts en niet van de veranderende patiënt. In de jaren
negentig wordt terughoudend beleid een norm binnen de
beroepsethiek van de huisarts. Het overbrengen van dit
terughoudende beleid op de patiënt is echter lastig. De invoering
van marktwerking maakt het voor huisartsen nog moeilijker om
terughoudend te zijn met het verlenen van zorg. Hoe de
beroepsethiek verder zal evolueren hangt af van de eensgezindheid
onder huisartsen en van toekomstig overheidsbeleid.Adviseren met beleid: Een onderzoek naar de doorwerking van adviezen van de Gezonheidsraadhttp://repub.eur.nl/pub/38661/
Sun, 01 Jan 2012 00:00:01 GMT<div>K.J. Grit</div><div>J. Dwarswaard</div><div>R.A. Bal</div>
Dit rapport gaat over Arduin, een organisatie die een pilot is gestart om vanuit
zelfsturende teams een doorontwikkeling te maken naar een organisatievorm waarbij
ouders en het sociale netwerk nauw betrokken zijn bij hun kind/kennis. De pilot
maakte onderdeel uit van de 10 experimenten van Wijk- en Buurtgericht Werken
2011. Doel van deze experimenten is om op wijkniveau de langdurige zorg ook in de
toekomst duurzaam, leverbaar en betaalbaar te houden. Door deelname werd een
proeftuin gecreëerd waarin vier pilotwoningen de mogelijkheid kregen om in de
praktijk te experimenteren en de grenzen op te zoeken en te overschrijden om te
ontdekken hoe Arduin zijn visie kan verwezenlijken.The doctor and the market: About the influence of market reforms on the professional medical ethics of surgeons and general practitioners in the Netherlandshttp://repub.eur.nl/pub/34118/
Thu, 01 Dec 2011 00:00:01 GMT<div>J. Dwarswaard</div><div>M.T. Hilhorst</div><div>M.J. Trappenburg</div>
To explore whether market reforms in a health care system affect medical professional ethics of hospital-based specialists on the one hand and physicians in independent practices on the other. Qualitative interviews with 27 surgeons and 28 general practitioners in The Netherlands, held 2-3 years after a major overhaul of the Dutch health care system involving several market reforms. Surgeons now regularly advertise their work (while this was forbidden in the past) and pay more attention to patients with relatively minor afflictions, thus deviating from codes of ethics that oblige physicians to treat each other as brothers and to treat patients according to medical need. Dutch GPs have abandoned their traditional reticence and their fear of medicalization. They now seem to treat more in accordance with patients' preferences and less in accordance with medical need. Market reforms do affect medical professional principles, and it is doubtful whether these changes were intended when Dutch policy makers decided to introduce market elements in the health care system. Policy makers in other countries considering similar reforms should pay attention to these results. The robustness of medical professional ethics when times are changinghttp://repub.eur.nl/pub/19420/
Thu, 01 Oct 2009 00:00:01 GMT<div>J. Dwarswaard</div><div>M.T. Hilhorst</div><div>M.J. Trappenburg</div>
Society in the 21st century is in many ways different from society in the 1950s, the 1960s or the 1970s. Two of the most important changes relate to the level of education in the population and the balance between work and private life. These days a large percentage of people are highly educated. Partly as a result of economic progress in the 1950s and the 1960s and partly due to the fact that many women entered the labour force, people started searching for ways to combine their career with family obligations and a private life (including hobbies, outings and holidays). Medical professional ethics, more specifically: professional attitudes towards patients and colleagues, is influenced by developments such as these, but how much and in what way? It was assumed that surgery ethics would be more robust, resistant to change and that general practitioner (GP) ethics would change more readily in response to a changing society, because surgeons perform technical work in operating theatres in hospitals whereas GPs have their offices in the midst of society. The journals of Dutch surgeons and GPs from the 1950s onwards were studied so as to detect traces of change in medical professional ethics in The Netherlands. GP ethics turned out to be malleable compared with surgery ethics. In fact, GP medicine proved to be an agent of change rather than merely responding to it, both with regard to the changing role of patients and with regard to the changing work life balance.